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Objective: To compare the Salbutamol alone and Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR. Study Design: Randomized Controlled Trial. Setting: Pediatrics Emergency, KRL Hospital Islamabad. Period: 1st August 2016 to 31 January 2017. Material & Methods: Group A patients were given only Salbutamol (0.15mg/kg per dose with minimum 2.5 mg, maximum 5 mg/dose). Group B was given Ipratropium Bromide supplemented Salbutamol (250 mcg/dose for 20kg of Ipratropium Bromide with same dose of Salbutamol as prescribed for Group A). Baseline spirometry was performed on each patient and after measurement of baseline peak expiratory flow. The outcome was measured by Peak flow meter and reassessed at 60 minutes. Results: Comparison of salbutamol alone and ipratropium bromide supplemented salbutamol in children with exacerbation of asthma in terms of PEFR shows that 40.5 + 4.28 in Group-A and 59.5 +4.75 in Group-B, P-value was calculated as 0.0001, showing a significant difference between the two groups while the difference in increase was recorded as 19%. Conclusion: We concluded that salbutamol alone is significantly less effective when compared with Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR.

Objective: To determine mean platelet volume in patients of psoriasis Study Design: Cross sectional study Place and duration of study: Dermatology Department, Pak Emirates Military Hospital Rawalpindi from August 2017 to January 2018. Methodology: Approval from the hospital ethical review committee was taken and a total of 100 patients were enrolled by non-probability consecutive sampling. After an informed written consent, name, gender, age, hospital record number, and phone number of each individual were noted. At the time of enrollment, all the individuals were subjected to complete blood count, bleeding time, fasting blood sugar, fasting lipid profile, renal and liver function tests. Patients with abnormal parameters were excluded from the study. A two ml venous blood sample was drawn from each patient and sent in CP bottle to the laboratory of Armed Forces Institute of Pathology for blood complete analysis by hematology analyzer machine. Data analysis was done using SPSS version 22. Results: In this study mean age was 40 ± 10.40 years. 54% patients were male and 46% patients were female. Mean platelet volume in patients presenting with psoriasis was 9.10fL with SD ± 2.12. Conclusion: Our study concludes that the mean platelet volume in patients presenting with psoriasis was 9.10fL with SD ± 2.12 which is in the normal range. Therefore, mean platelet volume is not affected by psoriasis. Key words: Mean platelet volume, psoriasis, severity, cross-sectional study

Purpose This study aims to examine the impact of sponsors and democratic government on the flipping activity of initial public offerings (IPOs). Design/methodology/approach Based on the sample of 95 IPOs listed on the Pakistan Stock Exchange between January 2000 and December 2019, this study used multiple cross-sectional regression to examine the relationship between sponsors and democratic government on flipping activity. Findings The findings indicate a significant negative association between sponsors and the flipping activity of IPOs. Sponsor(s) signal quality by trying to share accurate information about company values. As a result, the confidence of rational investors in the company’s future prospectus increases and they hold their shares for future gains, which reduces the flipping activity. Also, democratic government, along with sponsors' participation, provides investors with liquidity immediately after listing. Practical limitations/implications The findings of this study have implications for investors as they may assist them make informed decisions about whether or not to invest in an IPO with high sponsor(s) ownership. In addition, issuers should consider the disclosure of sponsor information(s) as such information may directly affect the first day’s trading volumes. Originality/value To the best of the authors’ knowledge, this is the first research study that explores the correlation between sponsors and democratic government and flipping activity of IPO. This study is important for investors and issuers.

PurposeThe purpose of this paper is to examine the impact of privatized initial public offerings (IPOs) on flipping activity in the Pakistan IPO market.Design/methodology/approachThis study sampled 95 IPOs listed on the Pakistan stock exchange over the period of 2000 to 2019. The ordinary least square technique and quantile regression were used to examine the impact of privatized IPO on flipping activity.FindingsThe present study finds that privatization affects flipping activity and creates a quality signal in Pakistan’s IPO market. The findings of this study also show that privatized IPOs were subjected to high levels of flipping activity compared to non-privatized IPOs. Additionally, investors’ demand has been found to moderate the relationship between privatized IPOs and flipping activity in Pakistan’s IPO market.Research limitations/implicationsBased on the fact that the sample consists of a combination of privatized and non-privatized IPOs, the results provide valuable insight into factors that may lead to unusual trading behavior/flipping during the first day of listing.Originality/valueDespite several studies on events (e.g. short- and long-term price performance) around IPO, there is little evidence on how privatized IPOs affect flipping activity, which is a high volume of trading immediately after listing.

Objective: To compare the efficacy of oral fluconazole and oral itraconazole in the treatment of Pityriasisversicolor. Study Design: Comparative prospective study. Methodology: Total 72 patients of both genders with Pityriasis versicolor were included. Patients were randomly allocated into two treatment groups with 36 patients in each group: group A and group B by lottery method. Patients in group A received Cap Fluconazole 150 mg bi- weekly for two consecutive weeks while those in group B received two doses of 400 mg of itraconazole once weekly for two weeks. Patients were asked to follow-up after 4 weeks skin scrapings for microscopy using 10% KOH mount was done at follow-up. Efficacy was assessed in terms of negative fungal hyphae on microscopy. Results: In this study, age ranged from 18 to 40 years with mean age of 33.52 ± 4.12 years in group A, whereas35.055 ± 4.18 years in group B. Mean duration of disease was 4.66 ± 1.51 months in group A and 5.27 ± 1.70months in group B. Efficacy was seen in 77.8% of group A patients as compared to 50% in group B patients(p=0.014). Conclusion: Oral Fluconazole two doses of 150 mg/week (total 300mg/week) for two consecutive weeks wasfound more effective than oral itraconazole.

Background: Healthcare related bacterial endocarditis represents a significant portion of endocarditis seen today. Suspicion for these infections should be particularly high in patients with chronic indwelling central venous catheters, and most notably, in patients with hemodialysis catheters. These infections may have a predilection for the superior vena cava due to proximity of the catheters to the great veins of the neck. Transthoracic echocardiography and/or trans-esophageal echocardiography should be done promptly in patients in which there a high suspicion for such infections, in order to identify these lesions, and guide appropriate management with either antibiotics or surgical intervention. Case presentation: We present a 59-year-old female with multiple comorbidities including diabetes mellitus and end-stage renal disease requiring dialysis via an anterior chest wall catheter, who presented with fever, chills, and abdominal pain. She was found to have pus in and around her catheter. Further evaluation with trans-esophageal echocardiography revealed the presence of a superior vena cava vegetation extending into the right atrium. She received a 6 week course of appropriate antibiotics with repeat trans-esophageal echocardiography showing a significant reduction in the size of the vegetation. Patient remained afebrile, and without leukocytosis and negative blood cultures for the remainder of her hospital stay.

Heterotaxy syndrome (HS) or situs ambiguous refers to the abnormal arrangement of viscera across the body axis, and abnormalities arise depending on the isomerism of the right or left atrial appendage. The cause remains unexplained and is attributed to a combination of genetic mutations and environmental factors. It is a rare condition and may remain undiagnosed for a long time. In this report, we aim to highlight an unusual presentation and aggravation of an infection due to the underlying isomerism of the left atrial appendage. We discuss the case of a female patient who presented with symptoms of fever and cough. The patient underwent prolonged antibiotic treatment, and her recovery was slow. The presence of bilobed lungs, vertical left-bronchus, and polysplenia on CT scan explained the left-sided aspiration pneumonia. The hypofunctioning spleen (polysplenia) caused her to have a weak immunological response, necessitating prolonged antibiotic use. She was followed up over time and had a recurrence of pneumonia within a few months. The condition is associated with high morbidity and mortality, and the role of early diagnosis and reporting to prevent complications is paramount. The recurrent pneumonia observed in the patient also raises questions related to long-term antibiotic use and immunization in the case of polysplenia in this patient population.

High-risk HPV is found in 99.7% of cervical cancers. The causative role of HPV in cervical cancer has led to the inclusion of HPV testing as part of cervical screening. A pilot of HPV testing as primary screening was commenced in 2013 at six pilot sites in England. North Cumbria Integrated Care (NCIC) NHS Foundation Trust took part in the pilot, in which women with an HPV-positive/cytology-negative result were recalled at 12 months. Women with HPV type 16/18 found at initial screening and persisting at 12 months in spite of negative cytology were referred to Colposcopy services at 12 months. Women with smear positive for hrHPV other than 16/18 types were recalled twice at 12 and 24 months before referral to colposcopy. Persistent hrHPV positive/cytology negative smear at 12 and 24 months initiated a colposcopy referral. Objective: To assess the prevalence of high grade CIN and invasive cancer in patients referred to colposcopy services at NCIC NHS Foundation Trust with hrHPV positive/cytology negative smears. Method: The study was conducted at NCIC NHS Foundation Trust between January 2015 and December 2017. Data was collected retrospectively from the colposcopy data base (INFOFLEX). All patients with HPV positive/cytology negative smears seen in colposcopy clinic during the study period were included. Patients with high grade CIN, cervical glandular intraepithelial neoplasia (CGIN) or invasive cancer were recorded. Results: 763 women were included in the study. A total of 50 (6.6%) women had high grade CIN, CGIN or invasive cancer. 40 of these 50 women (80%) were treated by large loop excision of the transformation zone (LLETZ). Conclusion: HPV primary screening is more effective than cytology-based screening. A high grade HPV positive result with negative cytology, persisting for one year in type 16/18 and for two years in other high-risk HPV types, warrants referral for colposcopy, as 6.6% of women in this study had high grade or invasive pathology.

In Dec 2019, a novel pathogen emerged, and within weeks, led to the emergence of the biggest global health crises seen to date. The virus called ‘SARS-CoV-2’, causes coronavirus disease which was named ‘COVID-19’ by the World Health Organization (WHO). The speedy spread of this infection globally became a source of public worry and several unknowns regarding this new pathogen created a state of panic. Mass media became the major source of information about the novel coronavirus. Much like the previous pandemics of SARS (2003), H1N1 (2009), and MERS (2012), the media significantly contributed to the COVID-19 infodemics. In this review, we analyze the role of mass media and public health communications from December 31, 2019 to July 15, 2020, and make scientific inferences. The COVID-19 pandemic highlights multiple social, cultural, and economic issues arising from the media’s arguable role. The racial prejudices linked to the origin of the virus prevented collaborations among scientists to find a solution. Media coverage of coronavirus news during geographical lockdowns, extended quarantines, and financial and social hardships induced fear and caused psychological stress. Domestic and elderly abuse upsurged. The unscientific cures and unverified medicines endorsed by the politicians and fake doctors proved harmful. The media played a worldwide role in coronavirus disease tracking and updates through live updates dashboard. The media allowed for timely interventions by the Center For Disease Control And Prevention (CDC) and the World Health Organization (WHO), enabling a rapid and widespread reach of public health communications. We saw an upward trend for the promotion of health and hygiene practices worldwide by adaption of safe health practices such as increased hand washing, use of face coverings, and social distancing. Media reinforced illness-preventing guidelines daily, and people were encouraged to use telehealth to meet their healthcare needs. Mass media has an imperative role in today’s world and it can provide a unified platform for all public health communications, comprehensive healthcare education guidelines, and robust social distancing strategies while still maintaining social connections. It can enable equal access to healthcare, end discrimination, and social stigmatization. The role of media and public health communications must be understood and explored further as they will be an essential tool for combating COVID-19 and future outbreaks.

Objective To compare the mean change of tooth movement in canine retraction between elastic module and Ni Ti coil spring. Study design Comparative study. Place and duration of study Orthodontics Department, Armed Forces Institute of Dentistry, Rawalpindi, from May 2015 to January 2016. Methodology Thirty-two patients were inducted. After alignment and extraction of maxillary first premolars, canine retraction was started with closed Ni Ti coil spring on one side of the maxillary arch and with active tie back on the other side. The distance between the lateral incisor and the canine was measured on both sides before starting canine retraction. The same measurements were recorded after four weeks of retraction. The difference between pre and post retraction measurements was recorded. The difference in the rate of canine retraction between both modalities was compared using independent sample t-test. Results The study included 56% females and 43% males. The mean rate of tooth movement in Ni Ti coil group and in the elastomeric module group was 1.1 mm and 0.7 mm in one month, respectively (p=0.05). Conclusion The rate of tooth movement is more rapid with Ni Ti coil spring than with the elastomeric module.

Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. The prevalence of GDM is on the rise due to increasing trends of obesity in females of child bearing age as well as due to increasing maternal age. Women at higher risk should be routinely screened of the condition and offered appropriate management in order to avoid fetal and maternal complications. GDM is associated with higher incidence of maternal and fetal complications during pregnancy and labour. There is a significant relationship between GDM and prediabetic states as well as high risk of developing type 2 diabetes mellitus. The aim of management is to keep glycaemic levels within specific targets to avoid adverse outcomes. Improved health related quality of life has been linked with treatment of gestational diabetes with active lifestyle, glucose monitoring and use of insulin. Historically, non pharmacological intervention and insulin have been the main approaches in management of GDM, though recently there is an emerging evidence of use of oral hypoglycemic agents. In this article we have reviewed the existing evidence and recommendations in management of GDM.

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a nonmalignant disease of unknown etiology. It may present as bilateral, massive, painless cervical lymphadenopathy; however, one third of the cases have extranodal involvement. Extranodal sites include soft tissue, skin, upper respiratory and gastrointestinal tracts, and central nervous system, with head and neck being the most common. Here we report a rare case of intracardiac RDD in a 46-year-old, African-American female who presented with worsening shortness of breath and fatigue for 7 weeks. Comprehensive physical examination was within normal limits; the patient had no lymphadenopathy. Echocardiogram revealed a large mass in the left atrium extending into the mitral valve. The mass was resected under the pretext of clinical diagnosis of myxoma, and the patient underwent a radical extended interatrial septectomy with bovine pericardial patch reconstruction. The 8-cm resected mass consisted of areas of fibrosis alternating with sheets of histiocytes enmeshed in a mixed inflammatory infiltrate. Histiocytes contained intact lymphocytes, plasma cells, neutrophils, and erythrocytes suggesting emperipolesis. The diagnosis of RDD was confirmed by immunohistochemistry. This case highlights the extranodal manifestation of RDD in the heart which could be easily mistaken for a myxoma on clinical and radiologic evaluation. RDD must be considered in the differential diagnosis of any patient who presents with a cardiac mass.

Genetically modified crops are new products of agriculture biotechnology. Rice is one of the top food crops that are modified genetically to fulfill the increasing food demand of the world. However, the benefits and risks of genetically modified crops are the topics of hot debate. Limited reports regarding the effects of genetically modified rice on the structure and function of soil microbial communities are available. Moreover, conclusions based on these studies are very perplexing and create a state of confusion regarding the impact of GM rice and their released products on soil microbiota and ecosystem. Few of the reports on transgenic rice recommend that if the transgene products from the GM rice become accumulated more than their utilization and/or biodegradation, it might cause accretion of these products in the soil beyond their safety level which may cause the long-term impact on the soil ecosystem including soil micro-fauna and micro-flora. Temporal and spatial factors are too much important in determining the influence of GM rice on communities of soil microbes and environment. Therefore, the following chapter is prepared to gather the information regarding the impact of GM rice and its residues on the soil microbial communities. In the first part, a brief description on the interaction of GM crops with soil microbes is presented, and in the second part studies regarding the impact of transgenic crops on the soil microbial communities are reviewed. At the end, a framework to evaluate the effect of GM rice on soil ecosystem relative to its parental variety is suggested.

Several electrophysiological parameters, including the auditory evoked response component M50/M100 latencies and the phase synchrony of transient and steady-state gamma-band oscillations have been implicated as atypical (to various extents) in autism spectrum disorder (ASD). Furthermore, some hypotheses suggest that an underlying neurobiological mechanism for these observations might be atypical local circuit function indexed by atypical levels of inhibitory neurotransmitter, GABA. This study was a randomized, placebo-controlled, double-blind, escalating-dose, acute investigation conducted in 25 14–18 year-old adolescents with ASD. The study assessed the sensitivity of magnetoencephalography (MEG) and MEGAPRESS “GABA” magnetic resonance spectroscopy (MRS) to monitor dose-dependent acute effects, as well as seeking to define properties of the pre-drug “baseline” electrophysiological and GABA signatures that might predict responsiveness to the GABA-B agonist, arbaclofen (STX-209). Overall, GABA levels and gamma-band oscillatory activity showed no acute changes at either low (15 mg) or high (30 mg) dose. Evoked M50 response latency measures tended to shorten (normalize), but there was heterogeneity across the group in M50 latency response, with only a subset of participants (n = 6) showing significant M50 latency shortening, and only at the 15 mg dose. Findings thus suggest that MEG M50 latency measures show acute effects of arbaclofen administration in select individuals, perhaps reflecting effective target engagement. Whether these subjects have a greater trend towards clinical benefit remains to be established. Finally, findings also provide preliminary support for the use of objective electrophysiological measures upon which to base inclusion for optimal enrichment of populations to be included in full-scale clinical trials of arbaclofen.

Objective:To determine the frequency of symptomatic osteoarthritis in general population of Karachi presenting with joint pain.Introduction:People easily get tired due to heavy duty occupations to keep pace with the society. Arthralgia commonly called as “Joint pain” is one of the most frequently observed complain, especially in individuals aged 50 above.Methods:A cross-sectional study was conducted at Jinnah Postgraduate Medical Centre (JPMC) from 1stNovember 2013 to 25thNovember 2013. The data was collected from 316 patients presenting to the department of rheumatology and orthopedics with joint pain. A structured questionnaire was designed based on the clinical symptomatology of osteoarthritis. It was administered to the participants aged above 18 yrs. old. 17.7% of males and 82.3% of females participated in the study.Result:Out of 316 patients with joint pain, 71.2% (n=225) were diagnosed osteoarthritis on the basis of symptoms present with a high prevalence in females than males. The most common joints to be involved in osteoarthritis were found to be knee joint (90.2%) and hip joint (55.7%). The majority of the patients (n=109) had an X-ray of their joint and n=125 was getting analgesics as an effective therapy for osteoarthritis.Conclusion:The frequency of osteoarthritis is increasing in Karachi with globalization due to high level occupational stress along with recreational activity stress and other contributive factors. Female predominance as compare to that of man is quite alarming that needs to be controlled for maintaining future quality of life and providing ease for daily activities. Link: http://aeirc-edu.com/ojs14/index.php/IJEHSR/article/view/138/305

Background Placenta accreta is a condition of abnormal placental attachment that was usually treated by hysterectomy. Techniques to conserve the uterus are now commonly used and series of subsequent pregnancy outcomes have been reported. The recurrence risk of placenta accreta is now a relevant detail and is currently not known. This work was performed to calculate the recurrence risk by reviewing the published literature. Methods A literature search using the terms "placenta accreta", "placenta percreta", "placenta increta", "abnormal placental attachment" and "placental attachment disorder" followed by hand-searching identified 6 papers that contained data concerning recurrence of placenta accreta in subsequent pregnancies following initial conservative treatment. Results Overall 407 pregnancies were recorded and 85.7% of women reported achieved a subsequent pregnancy following conservative treatment. The risk of recurrence of placental attachment disorder in a subsequent pregnancy was 19.9% (weighted mean, 95% CI 12.2-27.7). Conclusions The recurrence risk of placental attachment disorder following uterine conservation treatments is 20% . This risk should be discussed with women with an antenatal diagnosis of a placental attachment disorder who may be considering uterine conservation in order to retain the option of a future pregnancy.

The prime objective of the current study is to investigate the major determinants of firm’s open innovation performance in Malaysian small and median-sized enterprises (SMEs). Recently, Malaysian SMEs have suffered from low open innovation performance. These SMEs are still struggling to get success in open innovation adoption. Decline in open innovation practices hampered the overall SMEs performance. To address this issue the current study adopted quantitative research approach and cross-sectional research design. A 5-point Likert scale was used to collect the data through mail survey. Two hundred (200) questionnaires were distributed among the managerial staff of SMEs in Malaysia by using area cluster sampling. Smart PLS3 (SEM) was utilized as a statistical tool. It was found that external knowledge, internal innovation and R & D department were the major determinants of firm’s open innovation performance. Thus, the current study contributed in the body of knowledge by revealing the real determinants of open innovation performance and R & D department as a mediator. Therefore, the current study is beneficial for SMEs to boost up the overall performance by accelerating open innovation system.

The complement system consists of a family of proteins that play a critical role in the innate immune system. Complement activation has been implicated in many chronic inflammatory diseases, including atherosclerosis. However, a number of experimental studies have highlighted a beneficial role of component C1q in early atherosclerosis and in diabetes mellitus (DM). Despite these data, there have been no studies that have specifically examined the utility of plasma complement C1q as a clinical biomarker in patients with known or suspected coronary artery disease. In this study, baseline plasma complement C1q levels were measured in 159 men with DM who were referred for coronary angiography and who were followed up prospectively for the development of all-cause mortality for 10 years. After adjustment for baseline clinical, angiographic, and laboratory parameters, reduced plasma complement C1q levels were an independent predictor of all-cause mortality at 10 years (hazard ratio 0.66, 95% confidence interval 0.52 to 0.84, p = 0.0006). In additional multivariate models that adjusted for a variety of biomarkers with established prognostic efficacy, complement C1q remained an independent predictor of all-cause mortality at 10 years. In conclusion, reduced levels of complement C1q are associated with an increased risk of all-cause mortality at 10 years in patients with DM referred for coronary angiography. Furthermore, this association is independent of a variety of clinical, angiographic, laboratory variables, including biomarkers with established prognostic efficacy in the prediction of adverse cardiovascular outcomes.

Background: Worry about risk for breast cancer and pain are associated withmammography use. Both have been found to be a barrier to mammography use by women.Objective: To examine the anxiety and pain associated with mammography use in a sample ofwomen stratified according to breast cancer risk. Design: This prospective observational study.Setting: Department of Obstetric and Gynecology, Benazir Bhutto Hospital. Period: August2011 to June 2012. Patients & Methods: Women awaiting screening mammography in thereception area were asked to complete a questionnaire containing demographics for calculationof breast cancer risk and the Likert scale for anxiety before the procedure and VAS forassessment of pain after the procedure. Results: Our study included 100 women undergoingscreening mammography with an average age of 53.9±8.8 years. 15% were classified “higherrisk” by the Gail model. The average anxiety level was 4.03±1.3 on Likert scale and average painduring the procedure was 3.3±2.18 on VAS. Significant differences (p

TIMP-4 is the newest member of a family of secreted proteins known as the tissue inhibitors of metalloproteases that selectively inhibit matrix metalloproteases. TIMP-4 is abundantly expressed in human cardiovascular structures and has been implicated in cardiovascular disease. Furthermore, it has also been shown to be a novel target of peroxisome proliferator-activated receptor gamma in rat smooth muscle cells, suggesting a potential role in diabetes mellitus as well. However, there have been no studies that have specifically examined the utility of baseline plasma TIMP-4 levels for the prediction of long-term adverse cardiovascular outcomes. In this study, baseline plasma TIMP-4 levels were measured in 162 male patients with diabetes mellitus who were referred for coronary angiography and followed prospectively for the development of all-cause mortality and enzymatically confirmed myocardial infarction (MI) out to 5 years. After adjustment for a variety of baseline clinical, angiographic and laboratory parameters, plasma TIMP-4 levels were an independent predictor of all-cause mortality (hazard ratio 1.60, 95% CI 1.13 to 2.26; p = 0.0082) and MI (hazard ratio 1.61, 95% CI 1.19 to 2.18; p = 0.0021) at 5 years. Furthermore, in additional multivariate models that adjusted for a variety of biomarkers with established prognostic efficacy, TIMP-4 remained an independent predictor of adverse outcomes. In conclusion, elevated levels of TIMP-4 are associated with an increased risk of long-term all-cause mortality and MI in patients with diabetes mellitus referred for coronary angiography. Moreover, this association is independent of a variety of clinical, angiographic, and laboratory variables, including biomarkers with established prognostic efficacy in the prediction of adverse cardiovascular outcomes.

Introduction: Intrauterine contraceptive devices generally carry a low risk of complications. Infection, possibly due to damage caused upon insertion, can occur and actinomycetaceae are the most likely cause of pelvic actinomycosis. \ud \ud Case report: A 41-year-old female presented with a two-month history of raised temperature, weight loss and abdominal tenderness. Contrast tomography imaging indicated pyometria and pelvic actinomycosis-like abscess linked to intrauterine contraceptive device use. Full microbiological reporting, including anaerobic cultures and 16S PCR, identified the bacterium Propionibacterium propionicum. A six-month course of amoxicillin resolved the infection and the patient made a full recovery. \ud \ud Conclusion: Increased IUCD-related actinomycosis awareness and improved diagnostics may increase detection of P. propionicum, a pathogen rarely reported on to date.

To evaluate the pregnancy outcomes of all patients who underwent electrosurgical cone biopsy of the cervix between January 2000 and December 2011 and subsequently became pregnant.Retrospective cohort study.District General Hospital in the North East of England.Patients were identified from the local colposcopy electronic data, Hospital Episode Statistics and Maternity electronic data. Data were collected on a pro forma with two sections: (1) treatment section and (2) pregnancy section. In the treatment section, year and indication for treatment, volume of cervix removed, histological results and marginal status of specimen were documented. In the pregnancy section, time interval between treatment and pregnancy, pre-treatment obstetric history, cervical length measurements, cervical suture, gestation and mode of delivery and neonatal outcome were documented. Data were analysed using SPSS.25 women achieved 47 pregnancies after electrosurgical cone biopsy treatment. Most common indication for cone biopsy was glandular neoplasia accounting for nearly half of the procedures; 21.2% of pregnancies ended in first-trimester miscarriages. The preterm delivery rate (37 weeks) was 19.4%. Volume of cervix excised was significantly greater in women who delivered preterm compared to women who delivered at term (p = 0.028). The rate of preterm delivery was significantly higher in post treatment pregnancies when compared to pregnancies before treatment in the same women (p = 0.02). The preterm delivery in post-treatment pregnancies was not related to the time interval between treatment and pregnancy (p = 0.54). There was no significant difference in miscarriage rates in pre- and post-treatment pregnancies (p = 0.98).Electrosurgical cone biopsy of cervix is associated with increased risk of preterm labour that is related to the volume of cervix excised.

Agriculture Information systems play crucial role in the development of economy of a country. When pest and diseases affect the crops there is a significant decrease in production. Agriculture Information system has been developed by collecting information about pest, diseases, harvesting and plantation. Agile methods are best suited for the development of Information System. In the software industry, agile methods are in practice at a very large scale because of its ability of accommodating the change, quick results and high level of customer's satisfaction. Scrum is an agile methodology which is used for software development. Existing Agriculture Information system is developed by applying waterfall model which has many flaws. In order to overcome those issues scrum is used for the development of agriculture system. There is no proper framework exist for the development of agriculture system using Scrum. The objective of this paper is to highlight the importance of the Scrum framework for agriculture system and suggested a framework which will support the development of agriculture system.

Pre-term delivery is the leading cause of neonatal mortality and morbidity. The aim of this study is to determine the diagnostic accuracy of the fetal fibronectin (FF) test in predicting pre-term birth, the test interpretation and subsequent action taken in normal clinical practice in a busy tertiary centre setting. A total of 133 symptomatic women were included in the study and underwent the FF test. The use of tocolysis and corticosteroids were significantly greater in test-positive patients (p < 0.001). A negative test for detecting pre-term delivery within 10 days of the test was 100% sensitive with 100% negative predictive value (NPV). Our study has confirmed that a negative FF is an excellent short-term test to exclude pre-term delivery. The use of FF testing in routine clinical practice results in test characteristics similar to those found in research studies. This implies that the conclusions reached by researchers can be reliably translated into clinical practice.

To assess the impact of pre-pregnancy counselling (PPC) on the health of diabetic women in early pregnancy as compared to their health at the time of PPC.Retrospective cohort study involving all the diabetic women who attended PPC and subsequently become pregnant in the decade 1997-2007. The proforma had two sections: one for the PPC visit and one for the booking visit. Details on demographic factors, control and complications of diabetes, folic acid, current medication, weight, contraception, smoking and alcohol consumption were documented.Fifty-seven women who became pregnant after PPC were studied. There was optimisation of diabetic control with a significant reduction in HbA1c levels at booking as compared to PPC (7.5% vs 8.8%, p0.0001). Diabetic surveillance (retinopathy and nephropathy screening) was up to date at the time of booking in80% of the cases. Alteration of insulin regimes was undertaken in ∼ 1 in 5 women. Folic acid was taken by most patients (48/54) at booking. There was no significant reduction in the number of women who smoked at booking compared to PPC.The effect of PPC was evident in the improvements in the markers of health of diabetic women in early pregnancy compared to at the time of PPC.